Provider Demographics
NPI:1811376742
Name:RAINBOW CENTER OF MICHIGAN, INC
Entity Type:Organization
Organization Name:RAINBOW CENTER OF MICHIGAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLPC LBSW CAADC C
Authorized Official - Phone:734-243-8707
Mailing Address - Street 1:14733 S. TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161
Mailing Address - Country:US
Mailing Address - Phone:734-243-8707
Mailing Address - Fax:
Practice Address - Street 1:14733 S. TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161
Practice Address - Country:US
Practice Address - Phone:734-243-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health